What’s Wrong With Me?

Reader's Digest (Canada) - - Contents - BY SYD­NEY LONEY IL­LUS­TRA­TION BY VIC­TOR WONG

A med­i­cal mys­tery re­solved. SYD­NEY LONEY

THE PA­TIENT: Macken­zie Hild,

27, a med­i­cal stu­dent from Ne­vada City, Calif. THE SYMP­TOMS: Ex­cru­ci­at­ing stom­ach pain

THE DOC­TOR: Dr. Christo­pher Skelly, chief of vas­cu­lar surgery and en­dovas­cu­lar ther­apy at the Univer­sity of Chicago Med­i­cal Cen­ter

MACKEN­ZIE HILD DREAMED of be­com­ing a doc­tor, so she trav­elled to Uganda in 2009, af­ter grad­u­at­ing from high school, to vol­un­teer in a med­i­cal clinic. Within a week, the then 19-year-old began ex­pe­ri­enc­ing a sharp pain in her up­per ab­domen ev­ery time she ate or drank. She also felt nau­seous. Hild at­trib­uted her symp­toms to malaria pills and was re­lieved when the pain faded once she re­turned home and stopped tak­ing them. But her symp­toms didn’t dis­ap­pear al­to­gether. “I went off to study pre-med in col­lege and still had oc­ca­sional stom­ach aches,” Hild says.

The next sum­mer, Hild re­turned to Africa, this time to Rwanda. Shortly af­ter, the pain be­came so in­tense that she al­most stopped eat­ing. In three months, she lost 13 kilo­grams. “When I stepped off the plane, my mother freaked out,” she says.

When her symp­toms didn’t im­prove, Hild’s GP re­ferred her to a gas­troen­terol­o­gist. The doc­tor pre­scribed acid-re­flux med­i­ca­tion and rec­om­mended high-calo­rie meals to help her gain weight. But by then, eat­ing had be­come in­tol­er­a­ble. “As long as I didn’t eat or drink any­thing, I wasn’t in any pain,” says Hild.

She re­turned to col­lege but began miss­ing classes. At five-foot-three, Hild weighed only 35 kilo­grams. The school doc­tor sent her to the hos­pi­tal, where she was placed in an anorexia

unit. Once eat­ing dis­or­ders were ruled out, she was tested for par­a­sites, HIV, Crohn’s disease—any­thing the doc­tors could think of. “They made me eat and gave me opi­oids af­ter­wards,” Hild says. Fi­nally, doc­tors in­serted a feed­ing tube into her stom­ach. When that didn’t help, they by­passed her stom­ach with a tube that ran from her nose to her in­testines. The pain dis­ap­peared.

Even with the tube, Hild needed to eat once a day to pre­vent her stom­ach from at­ro­phy­ing. “I’d choose a time, then curl up on my bed for the next three hours,” she says.

The tube caused si­nus in­fec­tions, rubbed her throat raw and made so­cial sit­u­a­tions awk­ward. A year later, doc­tors re­placed it with one that en­tered into her ab­domen.

Back at school, Hild wore a back­pack that de­liv­ered liq­uid food to her in­testines. In 2014, while work­ing in South Africa, she was con­tacted by a med­i­cal stu­dent and pa­tient ad­vo­cate from Cal­i­for­nia who had heard about her case and wanted to run it by more spe­cial­ists.

Even­tu­ally it reached Dr. Christo­pher Skelly in Chicago, who sus­pected she had me­dian ar­cu­ate lig­a­ment syn­drome.

MALS de­vel­ops when a lig­a­ment at the base of the di­aphragm crosses the aorta and com­presses the celiac artery, which car­ries blood to the stom­ach. “It’s a chal­leng­ing disease be­cause not much is known about it,” Skelly says. “Although it’s com­mon, it’s not of­ten di­ag­nosed.”

The con­di­tion oc­curs in about 20 per cent of the pop­u­la­tion, but only one per cent ex­pe­ri­ence pain. “We don’t know whether it’s caused by com­pres­sion of the artery, com­pressed nerves or in­flam­ma­tion,” Skelly says.

Hild had been pre­vi­ously screened for MALS, but she was tested in­cor­rectly and the re­sults were neg­a­tive. Skelly re­did the tests and saw ev­i­dence of celiac com­pres­sion on a CT scan. The only so­lu­tion for most peo­ple is la­paro­scopic surgery. He told Hild, “If you want it done, I’ll do it.”

In Fe­bru­ary of 2015, Hild un­der­went the two-hour pro­ce­dure. “The surgery doesn’t work for ev­ery­one,” Skelly says. “About 70 per cent of cases are suc­cess­ful, so we try to man­age ex­pec­ta­tions—it can be dev­as­tat­ing when it doesn’t work.”

When Hild woke from surgery, she ate scram­bled eggs and cried with relief when she was pain-free.

At 27, Hild is now in her third year of med­i­cal school. She can swim and eat dark choco­late, the two things she missed the most. “I still have some is­sues, and my stom­ach is still re­ally small, but I can han­dle a lit­tle dis­com­fort com­pared to what it was,” she says. “Ev­ery morn­ing I wake up and thank my lucky stars for Dr. Skelly.”

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